Outcomes of Pediatric End Stage Renal Disease Patients with Moderate To Severe Covid-19 Infection Who Underwent Hemodialysis With Hemoperfusion In A Tertiary Subspecialty Hospital In Metro Manila: A Retrospective Single Center Study (preprint)

ABSTRACT

BACKGROUND  SARS-COV 2 became a pandemic in the early part of 2020 affecting individuals of all ages. Patients with End Stage Renal Disease who have COVID-19 infection are at higher risk for morbidity and mortality. There are studies on the use of of hemoperfusion in patients with COVID, however, data on its use in the pediatric population are scarce and conflicting.  OBJECTIVE  The objective of this study is to determine the clinical outcomes of pediatric end stage renal disease patients with moderate to severe COVID-19 infection who underwent hemodialysis with hemoperfusion in a tertiary subspecialty hospital in Metro Manila  METHODS  Retrospective cohort study was done. All eligible patients were included in the study. Data collection was conducted through chart review of medical records of ESRD patients <19 years of age admitted at the National Kidney and Transplant Institute from March 1, 2020 to March 1, 2022, presenting with moderate to severe COVID infection. Inflammatory markers and Chest xray were repeated to compare the values from baseline after 1-4 sessions of hemoperfusion. Clinical outcomes were determined in terms of discharge, duration of hospital stay, resolution of symptoms, progression of the severity of COVID infection, and final disposition either death or discharged.  RESULTS  C-Reactive Protein (CRP), Erythrocyte Sedimentation Rate (ESR), Lactate Dehydrogenase (LDH), and Ferritin decreased after 2-3 sessions of hemodialysis with hemoperfusion but the results were not statistically significant. Procalcitonin significantly decreased after the second session (p=0.046). Pneumonia on Chest xray decreased across all sessions. All patients showed clinical resolution of symptoms and were discharged.  CONCLUSION  The combined use of hemodialysis and hemoperfusion can be used as adjunct treatment for moderate to severe COVID infection after maximizing supportive and medical management. Should it be employed, 2-3 sessions are safe to improve the patient’s clinical status.   Keywords End Stage Renal Disease, COVID-19 infection, hemoperfusion, inflammatory markers